U.S. patent application number 10/819092 was filed with the patent office on 2005-05-19 for remote monitoring of an instrumented orthosis.
Invention is credited to Oyen, Duane P., Tracey, Timothy N..
Application Number | 20050107726 10/819092 |
Document ID | / |
Family ID | 34572654 |
Filed Date | 2005-05-19 |
United States Patent
Application |
20050107726 |
Kind Code |
A1 |
Oyen, Duane P. ; et
al. |
May 19, 2005 |
Remote monitoring of an instrumented orthosis
Abstract
An instrumented orthosis is interfaced to a telecommunication
system such that a patient and health care professional can
exchange communications including the monitoring of the
instrumented orthosis. Thus, a health care can evaluate
rehabilitation treatments based on an instrumented orthosis from a
remote location while obtaining real-time feedback from the
patient. The communications can include audio and/or video
transmissions.
Inventors: |
Oyen, Duane P.; (Maple
Grove, MN) ; Tracey, Timothy N.; (Wayzata,
MN) |
Correspondence
Address: |
Patterson, Thuente, Skaar & Christensen, P.A.
4800 IDS Center
80 South 8th Street
Minneapolis
MN
55402-2100
US
|
Family ID: |
34572654 |
Appl. No.: |
10/819092 |
Filed: |
April 6, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10819092 |
Apr 6, 2004 |
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09382433 |
Aug 25, 1999 |
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6872187 |
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Current U.S.
Class: |
602/16 |
Current CPC
Class: |
G16H 20/40 20180101;
A61F 5/0102 20130101; G16H 40/67 20180101 |
Class at
Publication: |
602/016 |
International
Class: |
A61F 005/00 |
Claims
What is claimed is:
1. An article comprising an instrumented orthosis, a microphone and
a telecommunication station comprising a plurality of input
channels and an output channel, wherein the instrumented orthosis
comprises a transducer that responds to forces or propagates forces
within the orthosis, wherein the instrumented orthosis and the
microphone are connected to the input channels of the
telecommunication station, and wherein the telecommunication
station can transmit from the output channel a multiplexed signal
in digital format performance values from the instrumented orthosis
over a network while exchanging oral communications with a person
on the network during a telecommunication session, the
telecommunication station exchanging performance values from the
instrumented orthosis and oral communications with a
telecommunications controller.
2. The article of claim 1 wherein the instrumented orthosis
comprises a microprocessor based controller.
3. The article of claim 1 wherein the instrumented orthosis
comprises energy propagating transducers.
4. The article of claim 1 wherein the telecommunication station
comprises a multiplexer connected to the microphone, wherein the
multiplexer is connected to the input channels and the multiplexed
out is connected to the output channel.
5. The article of claim 1 wherein the telecommunication station
comprises a video camera.
6. The article of claim 1 wherein the telecommunication station
comprises a modem, which is connectable to a phone line.
7. The article of claim 6 wherein the telecommunication station can
access a network server that can address a web site chat room
enabling the simultaneous communication with a remote site and
transfer of data from the instrumented orthosis.
8. The article of claim 1 wherein the telecommunications station
comprises a microprocessor.
9. The article of claim 8 wherein the microprocessor performs
multiplexing of the data from the input channels connect to the
instrumented orthosis and oral communication from the microphone
and the multiplexed output from the microprocessor is connected to
the output channel.
10. A method of rehabilitating an injured joint, the method
comprising exchanging transmissions in digital format over a
telecommunication channel, the transmissions including interspersed
real-time oral communications between a patient and a health care
professional and values from an instrumented orthosis interfaced
with a telecommunication station, the instrumented orthosis
comprising a transducer that responds to forces within the orthosis
wherein the values from the instrumented orthosis relate to the
output of the transducer and the telecommunication station
exchanging values from the instrumented orthosis and oral
communications over the telecommunications channel with a
telecommunications controller.
11. The method of claim 10 wherein the real-time communications
comprise oral statements made by the patient and by the health care
professional.
12. The method of claim 11 wherein the real-time communications
further comprise video transmissions of the patient.
13. The method of claim 10 wherein the telecommunication channel
comprises an internet connection.
14. The method of claim 10 wherein the telecommunication channel
comprises a satellite.
15. The method of claim 10 wherein the telecommunication channel
comprises a server that links the patient and health care
professional.
16. The method of claim 10 wherein the instrumented orthosis
comprises a microprocessor based controller.
17. The method of claim 16 further comprising remotely
reprogramming the controller.
18. The method of claim 10 wherein the telecommunication station
comprises a multiplexer connected to a microphone.
19. The method of claim 10 wherein the telecommunications station
comprises a microprocessor that performs multiplexing of data from
the instrumented orthosis and oral communication from a
microphone.
20. The method of claim 10 wherein the telecommunication channel
comprises a modem or a high speed communications line.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of copending U.S. patent
application Ser. No. 09/382,433 to Stark et al., entitled "Orthoses
For Joint Rehabilitation," incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0002] The invention relates to a system incorporating
telecommunication capability to assist with rehabilitation
involving an instrumented orthosis.
[0003] Both muscles and bones should be exercised to maintain
strength. Also, bone fractures that are exposed to permissible
weight bearing stress often heal more predictably and more rapidly
than fractures that are not stressed at all. Improved healing based
on application of appropriate stress is also believed to be true
for connective tissue, such as ligaments and certain cartilage.
[0004] Suitable stress can be applied to the tissue by the
performance of selected exercises. For example, isometric exercises
generally involve the exertion of force against a relatively
immovable object. To perform isometric exercises, a restraining
device can be used that has a substantially unchanging position for
the duration of a particular exercise routine. Isotonic exercises
involve exertion against the same weight or resistance through a
range of motion. Isokinetic exercise is designed to mimic exertions
that take place on a playing field or the like. When performing
isokinetic exercises in a simulated environment, a machine is used
to provide resistance in direct proportion to the exertion of the
exerciser.
[0005] Isometric exercises are particularly useful with painful
injuries to lower the risk of further injury. If performed in a
controlled manner, isometric exercises can be performed earlier in
the recuperation period to speed recovery. As the patient's
recovery progresses, isotonic exercises or other exercises can be
used to reestablish a desired range of motion about a joint. As
recovery progresses eventually the patient is able to perform a
full range of exercises.
[0006] A difficulty with the application of stress to an injured
joint is that the application of excessive stress can further
injure the joint rather than assist with the healing. Thus, the
exercises need to be carefully planned to provide appropriate
amounts of stress. Also, the performance of the exercises should be
monitored closely by a physician, physical therapist or other
appropriate health care professional to reduce the risk of injury.
The need to carefully plan and closely monitor the exercises
provides a cost and motivation barrier to accessing desirable
amounts of rehabilitation exercise.
[0007] Instrumented braces provide for the performance of exercises
with immediate feedback. The feedback can prevent the patient from
applying injurious forces and can prompt the patient to begin
exercising. Instrumented braces can also have the capability of
storing the patient's exercise performance parameters for later
downloading to a health care professional for evaluation.
SUMMARY OF THE INVENTION
[0008] In a first aspect, the invention pertains to an article
comprising an instrumented orthosis and a telecommunication
station, wherein the instrumented orthosis is connected to the
telecommunication station for the transfer of information, and
wherein the telecommunication station by way of a network transmits
performance values from the instrumented orthosis while exchanging
oral communications during a telecommunication session.
[0009] In another aspect, the invention pertains to a method of
rehabilitating an injured joint, the method comprising exchanging
transmissions over a telecommunication channel, the transmissions
including real-time communications between a patient and a health
care professional and values from an instrumented orthosis
interfaced with a telecommunication station.
[0010] In a further aspect, the invention pertains to a method of
adapting an instrumented orthosis for real time, remote evaluation
by a health care professional, the method comprising interfacing
the instrumented orthosis with a telecommunication station.
[0011] In addition, the invention pertains to a method of
evaluating output from an instrumented orthosis, the method
comprising producing a computer database including data from the
performance of a plurality of patients using a comparable
instrumented orthosis.
[0012] Furthermore, the invention pertains to a method of
evaluating treatment with an instrumented orthosis, the method
comprising exchanging communications between the patient and a
health care professional by way of a video teleconference over a
computer network.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] FIG. 1 is a schematic view of a system involving an
instrumented orthosis and a telecommunication device.
[0014] FIG. 2 is a schematic, perspective view of a simple
instrumented orthosis.
[0015] FIG. 3 is a schematic, perspective view of an instrumented
orthosis designed to fit around a patient's joint.
[0016] FIG. 4 is a schematic, top view of an orthosis
controller.
[0017] FIG. 5 is a schematic, top view of a microprocessor based
orthosis controller.
[0018] FIG. 6 is a schematic view of an auxiliary communications
network.
[0019] FIG. 7 is a schematic view of a real-time, remote
rehabilitation system based on an instrumented orthosis and a
telecommunication network.
[0020] FIG. 8 is a flow chart outlining a preferred embodiment for
the operation of a network based telecommunication device
interfaced with a microprocessor based instrumented orthosis.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0021] Instrumented orthoses can be interfaced with a
telecommunication device to provide for real-time, remote
monitoring of rehabilitative treatment by a health care
professional, e.g., physician or physical therapist. In preferred
embodiments, output from the orthosis is sent along the
communication channels of the telecommunication device, although
the orthosis output can be sent along an alternative communication
pathway. A health care professional can receive the information
from the orthosis and communicate with the patient to simulate the
evaluation of the patient in the office of the health care
professional.
[0022] Telecommunication as used herein includes teleconferencing
relating to two or more remote locations transmitting audio
communications and videophones/videoconferencing relating to two or
more remote locations transmitting video and, generally, audio.
Using the telecommunication approaches described herein, problems
and concerns can be addressed quickly and efficiently without the
expenditure of considerable effort and cost involved in scheduling
a personal visit by the patient to the health care professional.
Because of reduced costs and increased efficiencies, the patient
can have increased numbers of sessions with the health care
professional remotely. Also, family members of the patient can be
involved in the remote sessions to assist patients who are limited
in mobility.
[0023] An instrumented orthosis generally includes a support
portion that is secured around a body portion of a patient. The
orthosis can be instrumented with various transducers to provide
output regarding patient manipulation of the orthosis. For example,
the transducers can measure the strain within the orthosis, or the
transducers can operate as position sensors to detect motion of the
orthosis. Similarly, the orthosis can include energy propagating
transducers that apply therapeutic transmission to the patient. In
addition, the transducers can involve a motor for joint flexing,
which can be part of a Continuous Passive Motion (CPM) device.
[0024] The instrumented orthosis includes a controller that
generally provides a detectable output to the patient related to
the value of the forces applied by the patient against the
orthosis. The controller can further include an analog-to-digital
(a/d) converter to provide a digital signal related to the analog
transducer output and/or a digital-to-analog (d/a) converter to
transform a digital signal into an analog signal to drive an energy
propagating transducer. In preferred embodiments, digital signals
can be directed to and/or from a microprocessor within the
controller for storage, manipulation and/or transmission to a
health care professional. Alternatively, a processor forming part
of a telecommunication device can be used to perform desired
functions with digital and/or analog signals relating to orthosis
performance.
[0025] A telecommunication device involves data transmission of
personal communication, generally in a digital format. Generally,
the telecommunication transmissions are facilitated by computers,
such as personal computers, at each end of the transmission. The
communications can be transmitted by satellite relay, microwave
relay, standard phone lines, digital phone lines (as part of an
integrated services data network (ISDN) or a broadband T1 line or
similar connection), other similar communication pathways or a
combination thereof. The communications can include audio and/or
video transmissions. In preferred embodiments, audio and video
transmissions are included such that the patient and health care
professional can communicate in a reasonable facsimile of a
personal interaction from a remote location. In other embodiments,
only a video transmission of the patient and audio transmissions by
both the patient and health care professional are sent to the
doctor along with the data transmission.
[0026] Preferred communication pathways include the internet, where
a host web site functions as the telecommunication controller. The
web site can provide a variety of other functions including
facilitation of data transfer without patient or health care
professional coordination. Also, the web site can provide for
maintenance and access to a patient data base.
[0027] Communication signals and signals related to transducer
response can be transmitted from the patient to a health care
professional. Similarly, communications from the health care
professional are transmitted back to the patient. Real-time
communications take place between individuals such that they have a
personal/live exchange while they are participating in a single
session. In preferred embodiments, the instrumented orthosis can be
interfaced directly with the telecommunication device such that the
digitized output related to the transducer values can be sent along
with the communication signals. Also, in preferred embodiments, the
health care professional can send a digital transmission to
reprogram a microprocessor based orthosis controller to instruct
the patient to perform modified exercises with the orthosis.
[0028] Referring to FIG. 1, a real-time remote monitoring system
100 includes an instrumented orthosis 102, a
telecommunication/networking device 104 and an orthosis interface
106. Telecommunication device 104 includes a first computer 108, a
second computer 110, a communication network 112, an optional
second communication network 114 and a remote monitoring display
116. First computer 108 is located at the location of the patient,
while second computer 110 is located at the location of the health
care professional. First computer 108 and second computer 110
transfer data by way of communication network 112.
[0029] Orthosis interface 106 can connect to first computer 108 or
to optional second communication network 114 (connection shown in
phantom lines). Second communication network 114 provides an
alternative pathway for the transfer of data from the instrumented
orthosis at the patient's location to the remote location of a
health care professional. Remote monitoring display 116 provides a
graphic display of the data from the instrumented orthosis at the
health care professional's remote location. Remote monitoring
display 116 can be embodied in a variety of different formats such
as a separate window on a display connected with second computer
110 or as a stand alone device, which can be connected to another
computer. Alternative connections at the location of the health
care professional are shown in phantom lines. Further details on
such systems and components are described below.
[0030] Instrumented Orthoses and Orthoses Interfaces
[0031] An instrumented orthosis is suitable for the performance of
monitored exercises by a patient and/or the propagation of
therapeutic energy fields. Referring to FIG. 2, an instrumented
orthosis 140 generally includes a support portion 142, a transducer
144 and a controller 146. Support portion 142 is designed to be
secured on a selected body portion. A variety of constructions can
be used for the support portions 142 such that a support portion
properly supports the respective body portion. For example, a
support portion can include one or more frame members, such as two
frame members that extend on either side of the body portion.
Straps, rigid connectors or the like can be used to connect the two
frame member to hold the support portion in place around the body
portion. The straps can be secured to the frame members with any of
a variety of fasteners, such as snaps, buckles, clamps and hook and
loop fasteners.
[0032] In alternative embodiments, a support portion surrounds the
corresponding body portion. These support portions generally are
rigid and can be constructed from a variety of materials. Preferred
materials for the construction of rigid support portions include,
for example, molded plastic shells, plaster, heat moldable
thermoplastics, heat shrink plastic and other cast forming
materials. Rigid support portions can be premolded in various
sizes, such that a particular size is selected "off-the-self" based
on measurements of the patient. Alternatively, rigid support
portions can be constructed to custom fit a particular patient.
Further description of the construction of support portions is
found in copending and commonly assigned U.S. Provisional
Application Ser. No. 60/098,779 to Stark et al., entitled "ORTHOSES
FOR JOINT REHABILITATION," incorporated herein by reference,
hereinafter "application 60/098,779". Application 60/098,779 is
incorporated by reference in its entirety as well as, specifically,
for the various features for which it is particularly referred to
herein.
[0033] In preferred embodiments, instrumented orthosis 140
functions as an orthopedic restraining device that restrains
flexibly connected body portions. Referring to FIG. 3, instrumented
orthosis 150 includes a plurality of support portions 152 connected
by a hinge 154. Suitable structures of hinge 154 may depend on the
structure of the corresponding support structures. For example, a
suitable hinge 154 can include two or more hinge units 156
connecting different frame members that rotate together around a
joint, as shown in FIG. 3. In other constructions, hinge 154 has a
single hinge unit that meets frame members at the joint.
[0034] Alternatively, support portions 152 can be connected with an
articulating hinge. An articulating hinge can be made with
resilient collapsible materials analogous to a bendable straw,
sliding sections that can slide past each other to articulate, or
other similar constructions. Sliding sections can be locked
relative to one another by way of clamps attached to slots defining
a range of motion, where the clamps are tightened manually with
wing nuts or the like, or electronically with solenoids or the
like.
[0035] Regardless of the structure of hinge 154, preferred hinges
154 are capable of locking and unlocking to provide for adjustment
of the angle of the hinge and for support of the joint without the
risk of undesired bending. Mechanical and electromechanical hinges
capable of selectively locking and unlocking are described in U.S.
Pat. No. 5,484,389 to Stark et al., incorporated herein by
reference. In particularly preferred embodiments, hinge units 156
are capable also of adjustment to yield a selected resistance to
rotation about the hinge for the performance of a variety of
exercises. A suitable electromechanical hinge with variable
resistance controllable by way of a control unit is described in
published PCT application WO 96/36278, entitled "An Orthopedic
Device Supporting Two or More Treatment Systems and Associated
Methods," incorporated herein by reference. A preferred embodiment
of a mechanical hinge with variable resistance/friction is
described in application 60/098,779.
[0036] Referring to FIG. 3, instrumented orthosis 150 generally
includes one or a plurality of transducers connected to a
controller 158. Suitable transducers include, for example, strain
gauges 160, angle sensors 164, energy propagating transducers 166,
or motorized flexing devices 168, such as a continuous passive
motion apparatus. Strain gauges 160 can be calibrated to measures
forces applied during isometric or isotonic exercises. Angle
sensors 164 are used to measure rotation of a hinge/joint for the
performance of any of a variety of exercises. Angle sensors 164 can
be based on one or more different measurement approaches, such as
angularly dependent variable resisters, digital optical
transducers, hall effect magnetometers or simple switches with
angle dependent contacts, to provide an angle dependent measurable
parameter. Strain gauges 160 and angle sensors 164 are described
further in application 60/098,779.
[0037] Energy propagating transducers can transmit ultrasound
radiation and/or electromagnetic radiation for therapeutic
purposes. It is known that propagating radiation of selected
frequencies helps to speed healing of certain injuries. Energy
propagating transducers used in instrumented orthoses and
combinations of various transducers are described further in
published PCT application WO 96/36278, entitled "An Orthopedic
Device Supporting Two or More Treatment Systems and Associated
Methods," incorporated herein by reference.
[0038] Continuous passive motion (CPM) devices provide for
range-of-motion exercises using a motor 170. Because of the use of
motor 170, the exercises are passive in the sense that the
patient's joint is moved without the need for applied forces by the
patient. The orthosis controller can operate a CPM device or the
like to flex a patient's joint and/or receive input from the CPM
device regarding the parameters of the passive motion activity. The
motor provides an effective transducer of electrical signals into
physical motion of the patient's joint(s). By their nature passive
motion devices involve a platform that interfaces with support
portions for corresponding body portions near the joint. CPM
devices are described further in, for example, U.S. Pat. No.
5,239,987 to Kaiser et al., entitled "ANATOMICALLY CORRECT
CONTINUOUS PASSIVE MOTION DEVICE FOR A LIMB, incorporated herein by
reference, and U.S. Pat. No. 4,934,694 to McIntosh, entitled
"COMPUTER CONTROLLED EXERCISE SYSTEM," incorporated herein by
reference.
[0039] When forces are applied by the patient against the orthosis
during exertion/exercise, the orthosis tends to change position
relative to the patient's joint. This shifting reduces the
effectiveness of exercises being performed with the orthosis and
may necessitate realignment of the orthosis for proper fit. The
orthosis can be designed to reduce or eliminate this shifting.
[0040] A first approach to prevent a knee orthosis from slipping
during exercise is to construct the orthosis with indentations in
the femur supracondylar area just above the knee. An alternative
solution involves the use of additional securing cuffs. Securing
cuffs are designed to be tightened more during exercise routines to
help secure the orthosis relative to the joint. Securing cuffs
include a gripping element and, for example, can be placed against
the leg above the knee such that when tightened, the gripping
element applies pressure above the kneecap and pushes on the knee
without pushing on the vasculature and lymphatic drainage
posteriorly. In other embodiments, the securing cuffs can be
appropriately placed. Cuffs can be tightened with a variety of
fasteners including hook and loop fasteners.
[0041] Another approach to securing the orthosis involves securing
the orthosis to a belt by way of one or more straps. Still another
approach involves reducing the friction of the surface contacting
the orthosis or part of the orthosis, for example, using a high
friction, polymer sleeve. Still another approach to securing the
orthosis involves the placement of crossed straps behind the joint.
The straps apply forces that tend to maintain the straps in the
fold of the joint. Furthermore, for a knee orthosis, the orthosis
can end with a heal cup with a strap or the like around the foot to
hold the bottom of the orthosis around the heal of the foot and to
fix the hinge at the knee.
[0042] With any of these approaches for inhibiting orthosis motion
during use, the method preferably distributes the restraining
forces sufficiently such that no portion of the skin is subject to
excessive pressures that could bruise the skin as well as damage or
interfere with neural or circulatory functions. Inhibition of
orthosis slippage is described further in application
60/098,779.
[0043] Referring to FIG. 4, a controller 200 includes, for example,
an a/d (d/a) converter 202, a power supply 204 and a display 206.
A/D (d/a) converter 202 is connected to power supply 204, display
206 and transducer 208. If transducer 208 produces an analog
signal, a/d converter 202 generally amplifies the signal and
produces a corresponding digital signal. The digital signal can be
output to orthosis interface 106 directly or following further
manipulation within controller 200. If transducer 208 is an energy
propagating transducer, a digital signal from orthosis interface
106 is converted into an analog signal that is directed to
transducer 208 at the appropriate frequency.
[0044] Power supply 204 generally is a primary or secondary, i.e.,
rechargeable, battery. Alternatively, for telecommunication
activities power supply 204 can be a line connected to the
telecommunications device. If the telecommunications device
includes a personal computer or the like, a 5 volt connection can
be made by way of the keyboard port. Suitable plugs are available
for tapping off of the keyboard port such that the keyboard is
plugged into the connection for the peripheral device, in this case
the controller 200. Display 206 can receive an analog or digital
signal from a/d (d/a) converter 202. Display 206 can include a
light display, a needle display, a digital display or the like.
Display 206 includes a suitable driver that may or may not further
amplify the signal.
[0045] In a preferred embodiment, controller 220 includes a
microprocessor 222, a power supply 224, a digital display 226, one
or more a/d converters 228, one or more d/a converters 230 and an
input 232, as shown in FIG. 5. A/D converter 228 and/or d/a
converter are connected to transducer 234. Microprocessor 222 is
connected to orthosis interface 106. Multichannel a/d or d/a
converters can be used in place of multiple a/d or d/a converters.
A preferred embodiment of an a/d converter 228 for amplifying and
digitizing values from a strain gauge is described in application
60/098,779.
[0046] The digital processor can be programmed in any of a variety
of computer languages including, for example, basic, assembler, C,
C++ and the like. Microprocessor based controllers generally also
include a real time clock, RAM and non-volatile storage such as
SRAM or EEPROMO. Similarly, microprocessor based controllers
generally include various input/output channels, such as, a keypad,
a digital display, such as an LED display, data link to a
transducer(s), and RS232 standard output for serial connection or
modem access. The construction of microprocessor based controllers
is described further in application 60/098,779.
[0047] In preferred embodiments, a microprocessor based controller
prompts a patient for the performance of a treatment session.
During the treatment session, the patient receives feedback
regarding the performance of the treatment. Microprocessor based
controllers can store and manipulate data regarding the treatment
session. This information can be downloaded at suitable times to a
computer of a health care professional, either remotely or by a
direct connection.
[0048] As shown in FIG. 1, orthosis interface 106 can connect
directly to a telecommunication device 104 or to a second
communications network 114. Referring to FIG. 6, second
communications network 114 includes a first signal
transmitter/receiver 236 and a second signal transmitter/receiver
238. Signal transmitter/receivers 236, 238 can be modems,
electromagnetic transmitter/receivers, or the like. The
corresponding signals propagate through an appropriate medium,
modem transmissions through phone lines or the like and
electromagnetic (radio) transmissions through space. Second signal
transmitter/receiver 238 is further connected to second
microprocessor 110 or remote monitoring display 116.
[0049] Telecommunication
[0050] Referring to FIG. 7, an embodiment of a
telecommunication/networkin- g system 300 includes a patient
telecommunication/networking station 302, a health professional
telecommunication/networking station 304 and a telecommunication
controller/host server 306. The patient telecommunication station
302 preferably includes a personal computer 310 or the like, a
multiplexer 312, a microphone 314, and an optional video camera
316. Microphone 314 and video camera 320 are connected to
multiplexer 322, which can be part of a board inserted within
computer 310 or a stand alone device connected to computer 310.
Multiplexer 322 can be removed and its functions carried out by
software within computer 310 after input of digitized
communications.
[0051] Health professional telecommunication station 304 includes a
personal computer 330 or the like, a multiplexer 332, a microphone
334, and an optional video camera 336. Microphone 334 and video
camera 336 are connected to multiplexer 332, which is connected to
computer 330. The precise nature and order of connections within
and from telecommunication stations 302, 304 can be altered for
compatibility and for convenience.
[0052] Orthosis controller 338 of an instrumented orthosis 340
connect by way of serial connection 342 to multiplexer 312. As
noted above, instrumented orthosis 340 can transmit relevant data
by a separate communication pathway than the pathway used for the
audio/video communication. FIG. 7 displays a preferred embodiment,
where the data from instrumented orthosis 340 is transmitted on in
series on the same communications pathway as the audio/video
signal.
[0053] Computers 310, 330 interface with communication devices 344,
346, such as a modem or a high speed communication line.
Ultimately, communication devices 342, 346 interact with network
connections 348, 350, such as a satellite transmission network, a
microwave communication network, the internet or other similar
network. Network connections 348, 350 provide access to
telecommunication controller 306. While computers 310, 330 can
serve as telecommunication controller 306 with suitable
modifications, telecommunication controller 306 preferably is a
distinct unit.
[0054] Telecommunication controller 306 includes multiplexers 352,
354. Additional multiplexers can be used to provide for interfacing
with additional telecommunication stations. Multiplexers 352, 354
feed into audio mixer 356 and video selector 358. Multiplexer 354
further feeds into processor 360 to provide data from the
instrumented orthosis 316 to processor 360. Audio mixer 356 and
video selector 358 interface with processor 360 to provide for
control of the exchange of audio and video data between work
stations 302, 304. Processor 360 includes a central processing unit
362, volatile and/or nonvolatile memory 364, a timer 366 and
input/output ports 368. Processor 360 can use a Windows.TM.,
Macintosh.TM., Unix.TM., or other operating system. Processor 360
connects to a display 370, generally through a serial
connection.
[0055] The coordination of the audio and video portions of the
communications by a telecommunication controller is described
further in U.S. Pat. No. 5,801,756 to Iizawa, entitled "Multipoint
Video Conference System," incorporated herein by reference, and in
U.S. Pat. No. 5,751,959 to Sato et al., entitled "Communication
Terminal Supervisory System and Communication Method," incorporated
herein by reference.
[0056] Generally, raw data or data following some analysis can be
downloaded by controller 338. Orthosis controller 338 can perform
some initial data analysis to reduce the amount of data that must
be stored and transferred. Similarly, data transferred by orthosis
controller 338 can be analyzed by computer 310 prior to
transmission to transmission to telecommunications controller 306.
If computer 310 is used to analyze the data prior to transmission,
multiplexer 322 should be connected appropriately. In any case, the
amount of data is generally small relative to the amount of data
associated with standard audio/video signals. Packets of data can
be transmitted/written by orthosis controller 338 in format for an
RS232 port or other type of serial port or parallel port using
suitable formats including standard formats. Possible display
formats for data from an instrumented orthosis is described in
application 60/098,779.
[0057] The orthosis controller 338 can be designed to assist with
the telecommunication process. In particular, the microphone and/or
video camera can be connected directly to controller 338, such that
controller 338 performs the necessary multiplexing. A specific
preprocessor can be used as a data manager. The controller can be
connected to a personal computer or the like by way of an RS-232
connection or other suitable protocol through a serial connection
or a parallel connection with power directed from the pc to the
controller for telecommunication applications.
[0058] In some preferred embodiments, networking by way of network
connections 344, 346 takes place by way of the internet or other
comparable system that may supersede the internet. A rapidly
growing number of individuals have access to the internet from
their homes. The internet provides extremely convenient and
inexpensive access to telecommunication capability that is
available to a growing number of people from their homes. For
valuable communication between a patient and a health care
professional, suitable telecommunication needs just moderate
quality communication available now over the internet.
[0059] The telecommunication equipment can be rented to a patient
with internet access for use during a rehabilitation period, if the
patent does not already own the necessary equipment. In preferred
embodiments, the patient can be supplied with a laptop computer
set-up for telecommunication, such as internet access, a
microphone/camera and software for linking to the orthosis, such
that difficulties with set-up are reduced or eliminated. Thus,
access can be provided inexpensively and conveniently to all
patients. Then, all patients with a phone line can take advantage
of these telecommunication capabilities described herein.
[0060] In one preferred approach, a provider hosts a web site that
can be accessed by both the patient and the health care
professional. World wide web servers are routinely set up to
operate chat rooms between individuals. After proper identification
of the patient and health care professional by user names and/or
passwords, they are linked in a "chat room" represented by a window
on their respective display screens. Internet service provider
software and web browsers generally enable host web servers to
set-up chat room windows on the remote user. Inexpensive
hardware/software packages are commercially available to adapt
personal computers running windows to provide telecommunication
capabilities to the health care professional and the patient.
[0061] While the discussion has focused on the transmission of data
from orthosis controller 338 to a remote location for analysis, in
some preferred embodiments orthosis controller 338 can be
reprogrammed by another computer using a serial connection. Using
the telecommunication system 300, orthosis controller 338 can be
programmed remotely by a health care professional during a
telecommunication session. The reprogramming can be based on
instructions provided by computer 330 of telecommunication station
304 or under input from computer 330 based on instructions
transmitted by telecommunication controller/host server 306.
[0062] Remote Monitoring of Orthosis via Telecommunication
[0063] Networking capability by way of a telecommunication
controller/host server 306 can be used also to facilitate transfer
of data, maintenance of a patient database, access to databases and
software, as well as telecommunication. A variety of approaches
have been described for transferring data between an orthosis
controller and a health care professional's computer. These
approaches include, for example, modem-to-modem transfer, radio
communication and direct transfer by way of an RS232 port, as
described in application 60/098,779.
[0064] Telecommunication controller/host server 306 provides a
particularly convenient alternative. With the configuration shown
in FIG. 7 or a comparable arrangement, the patient can download the
data to the controller 306. The data is stored on controller 306
for retrieval by the health care professional at their convenience.
The data transfer can take the form of an e-mail attachment or the
like. This eliminates the need for any direct coordination between
the patient and the health professional. More generally,
controller/server 306 can serve as a drop off point for
communications of all types between patient and health care
professional. If desired, these communications can take the form of
e-mail or a bulletin board that is accessible with a password.
[0065] In preferred embodiments, data stored on controller/server
306 is separated from any patient identification and added to a
patient database. A patient database provides a basis for improving
therapy approaches by statistically evaluating treatment approaches
and by permitting a comparison with results of other similar cases.
In other words, the database can include real-time access to
compilations of raw data, statistically analyzed data and/or
comparative analyses. Preferably, the database is accessible at any
time by the health care professional including during a
telecommunication session with the patient.
[0066] Controller/server 306 can also provide access to software
for either the telecommunication stations and/or an orthosis
controller. For example, software upgrades based either on
revisions of the software or modification indicated by treatment
results can be directly downloaded over the network to the
telecommunication stations. Similarly, software for orthosis
controller 338 can be downloaded directly from controller/server
306 under the direction of the health care professional. The
downloading of software to orthosis controller 338 can be performed
as part of a telecommunication session or during a separate visit
by the patient to the controller/server based on previous
instructions from the health care professional.
[0067] The capability of having real-time, remote monitoring of the
treatment program by way of the telecommunication capability
potentially provides a variety of useful purposes. While a health
professional generally shows a patient how to use the orthosis
during a fitting of the orthosis, telecommunication capability
enables the health professional to walk through the procedure again
from a remote location to reassure the patient. This reassurance
can improve patient compliance while reducing patient stress. Also,
patient questions can be answered at an early time in the treatment
program, such that the treatments are properly performed, without
burdening the health professional.
[0068] In addition, if a patient is having difficulty with
treatments, a telecommunication session provides for very efficient
remote evaluation of the problem at a without requiring the patient
to travel to the professional's office. Thus, scheduling
difficulties can be reduced significantly. This provides a
convenience to both the patient and to the health professional.
While transducer data can be sent at roughly the same time as
communications between the patient and the health care
professional, the data from the orthosis can be sent prior to the
start of a telecommunications session between the patient and the
health care professional, if desired. Thus, the health care
professional can review the orthosis data prior to the
telecommunication session, preferably a teleconferencing session at
an internet web page or the like.
[0069] A typical telecommunication session is outlined with a flow
diagram in FIG. 8. First, the patient and health professional
log-on 400 the web site. Based on user names, passwords or other
information entered, the patient and health professional are
connected 402 in a chat room. Through the chat room window, the
patient and health professional exchange 404 personal
communications and data regarding the performance of the treatment
program. Generally, the health care professional opens another
window to display the data from the instrumented orthosis, although
other approaches are discussed above. Based on the personal
communications and an examination of the orthosis data, the health
professional evaluates 406 the patient performance.
[0070] To assist with the professional's evaluation, the health
care professional can select 408 to access a patient database. If
the professional decides to access the database, they open 410
another window for database access. The desired information is
accessed 412 from the database. Whether the database is accessed or
not, the health professional decides 414 whether or not the
treatment program should be modified.
[0071] If the health professional decides to modify the treatment
program, the modified treatment program is designed 416. Then, the
modified treatment program is downloaded 418 to the orthosis
controller 338. In preferred embodiments, orthosis controller 338
is responsive to remote programming. Thus, the reprogramming can be
performed during the telecommunication session. If desired, the
reprogrammed treatment program itself can be evaluated during the
telecommunication session shortly after the reprogramming is
performed.
[0072] Once any modifications are made to the programming of
orthosis controller 338, the health professional verifies 420 the
patient's expectations regarding compliance and their satisfaction
420. Upon completion of the telecommunication, the patent and
health professional log-off 422 of the chat room and log-off 424 of
the network.
[0073] The embodiments described above are intended to be
illustrative and not limiting. Additional embodiments are within
the claims below. Although the present invention has been described
with reference to preferred embodiments, workers skilled in the art
will recognize that changes may be made in form and detail without
departing from the spirit and scope of the invention.
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